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Annual Competition Results

The Arthritis Society’s research investments

The Arthritis Society funds only the best, most scientifically meritorious research proposals that offer the greatest hope for improvements in our ability to diagnose, prevent, treat, repair and lead to a cure for arthritis.

In 2017-18, the Arthritis Society has committed over $4 million to arthritis research and the development of researchers and clinicians.

Project Summary:

Why?: OA is different from other types of arthritis with high-grade inflammation (e.g. rheumatoid arthritis). OA presents with low-grade, chronic, and often intermittent inflammation. Research has shown that inflammation in the lining of joints from people and animals with OA contains high numbers of immune cells called macrophages.

What?: This project proposes to answer these questions:

Are OA macrophages mainly pro-inflammatory or anti-inflammatory, and are they different in early vs. late stages, and in post-traumatic OA vs. metabolic OA?

What are the gene expression profiles of OA macrophages in different stages and types of OA?

Does treatment that specifically causes loss of macrophages reduce or accelerate OA, and does the effect depend on treatment timing or type of OA?

How?: Use two animal models of post-traumatic OA to examine the knee joint tissues to assess whether the macrophages present in early and late knee OA are mostly pro-inflammatory vs. anti-inflammatory, and whether the macrophages occurring in each type of OA are different.

Use advanced genetic tools to measure the expression of all macrophage genes, which will give us critical insight into how these cells are functioning at different stages of each type of OA.

Use a treatment to selectively remove all macrophages from the rats while OA develops, or after OA has been established.

Impact?: To help us understand if macrophages worsen or protect against knee OA, and whether these cells behave differently in early and late OA of different types.

If a treatment is developed, the knowledge gained from these critical experiments may help us personalize how, when, and in which types of patients a macrophage targeting treatment might work best.

To prepare us to test how we could strategically leverage the anti-inflammatory functions of macrophages in future studies to improve OA outcomes.

Project Lay Summary:

Osteoarthritis (OA) is by far the most common type of arthritis. Many people think OA is just “wear and tear” arthritis and don’t know that OA also involves inflammation. Importantly, OA is different from other types of arthritis with high-grade inflammation (e.g. rheumatoid arthritis). OA presents with low-grade, chronic, and often intermittent inflammation. Research has shown that inflammation in the lining of joints from people and animals with OA contains high numbers of immune cells called macrophages.

In this study, we will test whether macrophages play a critical role in the development and progression of two types of OA seen very commonly in people: OA after joint injury (post-traumatic OA), and OA with changes in the body’s metabolism such as obesity (metabolic OA). Interestingly, some macrophages promote inflammation while others help to control inflammation and promote tissue healing. However, a critical knowledge gap exists. It is unknown whether the main roles of macrophages are affected by different stages or different types of OA.

This project proposes to answer these questions: 1. Are OA macrophages mainly pro-inflammatory or anti-inflammatory, and are they different in early vs. late stages, and in post-traumatic OA vs. metabolic OA? 2. What are the gene expression profiles of OA macrophages in different stages and types of OA? 3. Does treatment that specifically causes loss of macrophages reduce or accelerate OA, and does the effect depend on treatment timing or type of OA?

Before we can safely answer these questions in humans, we need to acquire more information about the role of macrophages in OA by using two well-established animal models of post-traumatic OA and metabolic OA in rats. First, we will examine the knee joint tissues to assess whether the macrophages present in early and late knee OA are mostly pro-inflammatory vs. anti-inflammatory. We will also see whether the macrophages occurring in each type of OA are different.

Next, we will use advanced genetic tools to measure the expression of all macrophage genes, which will give us critical insight into how these cells are functioning at different stages of each type of OA. Finally, we will use a treatment to selectively remove all macrophages from the rats while OA develops, or after OA has been established. Comparing the severity of OA with and without macrophages, at different stages of the disease, and in different types of OA, will give us critical knowledge about these inflammatory cells. Our long-term goal is to find treatments for the symptoms and damage caused by OA in our patients.

This project will help us understand if macrophages worsen or protect against knee OA, and whether these cells behave differently in early and late OA of different types. If a treatment is developed, the knowledge gained from these critical experiments may help us personalize how, when, and in which types of patients a macrophage targeting treatment might work best. The study will also prepare us well to test how we could strategically leverage the anti-inflammatory functions of macrophages in future studies to improve OA outcomes.

Project summary:

Why?: The most characteristic feature of scleroderma is the build-up of tough scar-like fibrous tissue in the skin. A cell type called the myofibroblast (a special form of fibroblast) is responsible for the overproduction of collagen and the development of tough scar tissue (a process called called fibrosis). The toughness of the scar tissue itself in turn acts on myofibroblasts to generate more collagen and scar tissue. We want to break this vicious cycle to treat scleroderma.

What?: The aim of our project is to identify if a protein called YAP1 (found inside the fibroblast) is responsible for generating the toughness of scar tissue.

How?: To test if:

Visudyne can block the generation and activity of myofibroblasts, and

The presence of YAP1 in fibroblasts is essential for the development of skin fibrosis in our animal models of scleroderma.

Impact?: Our project could ultimately result in the use of these drugs to treat scleroderma.

Project lay summary:

Need/Gap addressed: According to The Arthritis Society's website: "the name scleroderma is derived from the Greek word skleros, which means hard, and derma, which means skin. The most characteristic feature of scleroderma is the build-up of tough scar-like fibrous tissue in the skin. The disease may affect the skin alone...or be a systemic disease that involves internal organs...Scleroderma begins with being born with the genetic potential to develop the disease. Something then triggers the immune system....to generate antibodies that attack healthy tissue.... This response produces inflammation and an overproduction of collagen " the tough fibrous protein that helps construct connective tissues, such as tendons, bones, and ligaments (and) scar tissue. This excess collagen is deposited in the skin and body organs." A cell type called the myofibroblast (a special form of fibroblast) is responsible for the overproduction of collagen and the development of tough scar tissue (a process called called fibrosis). The toughness of the scar tissue itself in turn acts on myofibroblasts to generate more collagen and scar tissue. We want to break this vicious cycle to treat scleroderma.

Research Question and Approach: The aim of our project is to identify if a protein called YAP1 (found inside the fibroblast) is responsible for generating the toughness of scar tissue. YAP1 is activated due to the acquisition of tough connective tissue and has increases levels of a gene called CCN2 that is essential for the development of scar tissue. Since drugs targeting YAP1 (e.g. Visudyne) have been in clinical use since the year 2000, they are safe to use in humans. Our project could ultimately result in the use of these drugs to treat scleroderma. In this project, we will test if:1) Visudyne can block the generation and activity of myofibroblasts, and 2) the presence of YAP1 in fibroblasts is essential for the development of skin fibrosis in our animal models of scleroderma.

Impact: We will: 1) Show if YAP1 inhibitors block the activity of myofibroblasts 2) Show if YAP1 is required for skin fibrosis 3) Provide evidence whether, in principle, YAP inhibitors could be used to treat scleroderma.

What?: A neuronal channel called NaV1.8 has been implicated in neuropathic pain and we have previously found that blocking this channel can alleviate OA pain. Joint neuropathic pain is mediated in part by NaV1.8 channels in a sex-specific manner.

How?: Joint nerve damage and neuropathic pain will be compared between male and female animals with knee OA. Animals will then be treated with a NaV1.8 inhibitor to see if there is a sex-specific difference in pain relief when blocking this nerve channel. Finally, we will develop a NaV1.8 antibody system which will be more effective at blocking this sodium channel and thereby prolong the analgesic window.

Impact?: To identify a novel treatment strategy for the alleviation of OA pain for patients who are unresponsive to the currently prescribed anti-inflammatory drugs. While this treatment would be suitable for both sexes, we predict that females will benefit more from this approach than males.

A promising target for the alleviation of neuropathic pain is a sodium channel present exclusively on pain-sensing nerves. These sodium channels are responsible for the electrical activity and resultant firing of pain-sensing nerves only. Thus, targeting these neuronal channels will reduce the nerve activity associated with neuropathic pain while maintaining normal sensitivity to touch and temperature.

One such channel, called NaV1.8, has been implicated in neuropathic pain and we have previously found that blocking this channel can alleviate OA pain. A limitation of the blocker, however, is that its pain-relieving effects are short lasting. Women are more likely to suffer from OA and experience more musculoskeletal pain compared to men. The reasons for this sex distinction are unknown, but differences in neurobiology is likely to play a major part. Neuropathic pain is more common in females and this is because females are more susceptible to peripheral nerve damage.

We believe this sex difference in neuropathic pain sensitivity is linked to variations in NaV1.8 levels. Thus, we hypothesize that: Joint neuropathic pain is mediated in part by NaV1.8 channels in a sex-specific manner. Joint nerve damage and neuropathic pain will be compared between male and female animals with knee OA. Animals will then be treated with a NaV1.8 inhibitor to see if there is a sex-specific difference in pain relief when blocking this nerve channel.

Finally, we will develop a NaV1.8 antibody system which will be more effective at blocking this sodium channel and thereby prolong the analgesic window. Our proposed studies will identify a novel treatment strategy for the alleviation of OA pain for patients who are unresponsive to the currently prescribed anti-inflammatory drugs. While this treatment would be suitable for both sexes, we predict that females will benefit more from this approach than males.

Project Summary:

Why?: An estimated 24,000 Canadian children live with arthritis. One in eight children with JIA (an estimated 3,000 Canadian children) also will have uveitis, which is inflammation of the middle layer of the eyes. The reasons why joint inflammation (arthritis) and eye inflammation (uveitis) occur together in some children are poorly understood.

What?: To help explain why joint and eye inflammation occur together in children.

How?: To investigate how collagen structure is changed by certain inflammation proteins, by studying a larger group of children with arthritis and over time see if testing their blood for the same markers can be used to predict who will develop uveitis.

Impact?: Early recognition of uveitis in children with arthritis and prompt treatment are essential to prevent blindness. By determining the mechanisms that explain the link between arthritis and uveitis in children, we can then design more specific treatments and gain insight into possible causes of the condition.

Project Lay Summary:

An estimated 24,000 Canadian children live with arthritis. One in eight children with JIA (an estimated 3,000 Canadian children) also will have uveitis, which is inflammation of the middle layer of the eyes. Despite intensive and often distressing therapies (for example, administration of eye drops to young children many times a day), up to one-third of affected children develop profound, permanent vision loss. As a young adult who has endured childhood onset arthritis and uveitis stated: “Arthritis and uveitis are independently life altering; together they can have devastating consequences. Lack of mobility or loss of sight can quickly strip the innocence of childhood.”

Uveitis is usually invisible to the patient until it causes eye damage. It can lead to permanent vision loss in one third of affected children. Early recognition of uveitis in children with arthritis and prompt treatment are essential to prevent blindness.

The reasons why joint inflammation (arthritis) and eye inflammation (uveitis) occur together in some children are poorly understood. We expect this research will help explain why joint and eye inflammation occur together in children. In our earlier studies of animals with joint and eye inflammation we identified collagen (a protein that is present in both the joint and the eye) as a possible common target that is attacked by the immune system of affected children.

In this research project, we will investigate how collagen structure is changed by certain inflammation proteins. Once altered, the collagen causes an immune reaction that leads to damage in the joint and the eye. In our prior studies in animals and in children affected with arthritis and uveitis we identified markers in the blood that are present when these two conditions occur together. Using this information we are now prepared to study a larger group of children with arthritis and over time see if testing their blood for the same markers can be used to predict who will develop uveitis.

By determining the mechanisms that explain the link between arthritis and uveitis in children, we can then design more specific treatments and gain insight into possible causes of the condition. For example, it is possible that certain infections could trigger the start of the inflammation in the joint and eye in children who have certain genetic characteristics.

This study will be conducted in childhood arthritis clinics across Canada. We will collaborate with Canadian ophthalmologists and other researchers from the United States and the Netherlands to ensure this study is undertaken quickly and efficiently to generate results that can be promptly applied to benefit affected children.

Project summary:

Why?: There are many treatments for osteoarthritis available, but the most effective and safest treatments are not known yet.

What?: Our objective is to determine what treatments work best for patients with osteoarthritis.

How?:

We will collect and critically evaluate all pertinent published trials over the last 30 years. We will employ sophisticated statistical techniques that are capable of estimating the benefits and harms of each treatment compared against each other, even if few or no head-to-head comparisons have been conducted.

We will develop a statistical model that will allow us to investigate the association between treatment effects of each conservative OA treatment and personal characteristics of people living with OA. This analysis will allow us to tailor the treatment of people living with OA according to their personal characteristics.

We will implement a freely available online platform to provide patients and clinicians access to the results of our analyses to facilitate shared clinical decision-making. This platform will use the characteristics of people with osteoarthritis (e.g. age, gender, disease severity) to inform users about the probability that each osteoarthritis treatment will cause more benefit than harm.

Impact?: The present project will develop and use novel methods to produce continuously updated knowledge to optimize the treatment of millions of persons living with osteoarthritis in Canada and worldwide.

Project lay summary:

There are many treatments for osteoarthritis available, but the most effective and safest treatments are not known yet. In this project, our objective is to determine what treatments work best for patients with osteoarthritis.

To accomplish this goal, we will collect and critically evaluate all pertinent published trials over the last 30 years. We will employ sophisticated statistical techniques that are capable of estimating the benefits and harms of each treatment compared against each other, even if few or no head-to-head comparisons have been conducted.

Furthermore, we will develop novel statistical models that enable the assessment of whether patient characteristics such as age, gender, disease severity, among others, are associated with a better response to different osteoarthritis interventions. Finally, we will implement a freely available online platform to provide patients and clinicians access to the results of our analyses to facilitate shared clinical decision-making.

This platform will use the characteristics of people with osteoarthritis (e.g. age, gender, disease severity) to inform users about the probability that each osteoarthritis treatment will cause more benefit than harm. As a whole, the present project will develop and use novel methods to produce continuously updated knowledge to optimize the treatment of millions of persons living with osteoarthritis in Canada and worldwide.

Project summary:

Why?: Despite advances in clinical care, people living with rheumatic disease (RD) continue to report trouble finding employment and staying productive at work. Because previous research focuses primarily on older adults with RD, it is unclear if Millennial young adults with RD, who are just beginning their careers, have the same needs when it comes to workplace support.

What?: To examine the needs of Millennials with RD within the workplace.

How?: Survey Millennial young adults with RD to learn more about their workplace support needs.

Impact?: Results will help employers, clinicians, and policy makers develop strategies that will assist Millennials with RD transition into the world of work, and ensure that they remain employed and productive once there.

Project lay summary:

Despite advances in clinical care, people living with rheumatic disease (RD) continue to report trouble finding employment and staying productive at work. Some previous research suggests that workplace policies and practices play an important role in overcoming these challenges. The research indicates that job accommodations (e.g., modified hours), work modifications (e.g., rearranging tasks) and extended health benefits (e.g., access to drug benefits) are examples of effective strategies for helping people with RD sustain employment and remain productive.

Because previous research focuses primarily on older adults with RD, it is unclear if Millennial young adults with RD, who are just beginning their careers, have the same needs when it comes to workplace support. Our study is one of the first to examine the needs of Millennials with RD within the workplace. Millennials (born 1982-1999) make up a growing portion of the labour force but are less likely to hold permanent full-time jobs. A RD adds to the challenges faced by Millennials as they transition into employment.

We will survey Millennial young adults with RD to learn more about their workplace support needs. Our survey will also identify how characteristics of a person’s health and their working conditions impact workplace support needs, and early work experiences. Our results will help employers, clinicians, and policy makers develop strategies that will assist Millennials with RD transition into the world of work, and ensure that they remain employed and productive once there.

Project summary:

Why?: The quality of care provided to Canadians with inflammatory arthritis (IA) is not routinely monitored in Canada, nor are patient clinical outcomes. Electronic medical records (EMRs) used by doctors capture information relevant for the day-to-day care of their patients including medical histories and the type of healthcare patients receive.

What?:

Our primary research questions include:

How complete are rheumatology EMRs?

Can we accurately and efficiently identify patients with IA conditions from the complete practice data

Is the data of sufficient quality to derive quality measures and support the measurement of quality of care and quality improvement efforts? Answering these questions will determine the feasibility and usefulness of using rheumatology EMRs for research and quality improvement purposes.

Secondly, we will also demonstrate the capabilities of using rheumatology EMRs to evaluate care and outcomes of IA patients. Some of the research questions that we will answer include:

How long are patients waiting to see rheumatologists?

Are there variations in wait times between rheumatologists?

Which factors are associated with timely care?

How?: We will securely collect EMR data from rheumatologists into a central database. We will assess the quality of this data to understand how we can use the data to measure detailed aspects of care. This will allow us to analyze the data to better inform healthcare delivery to ensure it is safe, effective and efficient and that patients achieve the best possible outcomes.

Impact?: This project plays an essential first step to enable the measurement of quality of care to catalyze quality improvement efforts using real-world data for all patients under rheumatology care. Our results will inform continuous quality improvement including timely access to rheumatology care and treatment as well as patient outcome to ensure Canadians with IA are receiving the best possible care and achieving the best outcomes.

Project lay summary:

The quality of care provided to Canadians with inflammatory arthritis (IA) is not routinely monitored in Canada, nor are patient clinical outcomes. Electronic medical records (EMRs) used by doctors capture information relevant for the day-to-day care of their patients including medical histories and the type of healthcare patients receive. This data can be anonymized and coded to protect patient privacy and confidentiality, and securely used for research and quality improvement activities.

We will securely collect EMR data from rheumatologists into a central database. We will assess the quality of this data to understand how we can use the data to measure detailed aspects of care. This will allow us to analyze the data to better inform healthcare delivery to ensure it is safe, effective and efficient and that patients achieve the best possible outcomes. We will do this by developing methods to evaluate quality of care using the EMR data. We will feedback this information to rheumatologists to help drive quality improvements. We will also evaluate wait times between rheumatologists and the effect of different models of care on wait times.

This project plays an essential first step to enable the measurement of quality of care to catalyze quality improvement efforts using real-world data for all patients under rheumatology care. Our results will inform continuous quality improvement including timely access to rheumatology care and treatment as well as patient outcome to ensure Canadians with IA are receiving the best possible care and achieving the best outcomes.

Project Lay Summary:

Patients with Rheumatoid Arthritis show increased susceptibility to develop cardiovascular complications, as compared to the general population. Unfortunately, current drug therapies do not completely limit or prevent the development of these complications. Multiple lines of evidence now support the importance of inflammatory pathways in the pathophysiology of both complications. Our research program aims to study and understand the mechanisms by which autoimmune disease such as Rheumatoid Arthritis and heart diseases develop, and more importantly, to establish the key inflammatory contributors that link both disorders. More precisely, we intend to delineate the importance of a critical inflammatory mediator in the onset of cardiovascular complications in patients with autoimmune diseases using specific animal models, human samples and blocking agents generated in our laboratory. This project may lead to the development of novel and safe therapeutic targets for the treatment of Rheumatoid Arthritis and its cardiovascular-associated complications.

Rehabilitation Sciences Institute, University of Toronto / University Health Network

Supervisor: Dr. Zahi Touma, University Health Network

Project title: Improving the assessment and care management of everyday living limitations in adults with Systemic Lupus Erythematosus related cognitive impairments: an multi-methods examination of activities of daily living

Project Lay Summary:

Need/gap: Over 35,000 Canadians live with the widespread effects on bodily functions and activities of daily living (ADL) associated with systemic lupus erythematosus (SLE). One significant body function area that can be affected is thinking skills, also known as cognitive functions. Cognitive impairments (CI or issues in thinking skills) can include declines in a person’s memory, planning, and attention abilities, as well as their thinking speed. It is estimated that up to two-thirds of people living with SLE experience CI, and these changes can have a significant effect on a person’s ADL performance. Decreased ADL performance can decrease life satisfaction and quality of life. Currently there is no study that has examined the ADL function of people living with SLE related CI.
Research question: For people living with SLE, do people who experience associated CI have different ADL limitations than people who do not experience associated CI?

Approach to address gap: This project will use three studies to answer the research question. The first study will review all of the available published studies that have examined ADL functioning in people with SLE. This literature includes both people with and without related CI, and reviewing it will help identify the possible ADL limitations related to SLE. The second study will interview people with SLE and related CI regarding how changes in thinking skills has affected their daily lives and ADL functioning. This study identifies what ADL issues might be specific to SLE related CI. The third study will compare the self-reported ADL limitations of (1) people with SLE and CI versus (2) people with SLE and no CI. This study will develop a survey of ADL limitations using information from the first two studies. The survey will be given to people with SLE identified as having or not having CI, and difference between the two groups’ self-reported answers will be compared.

Impact to arthritis care: The results of this study are needed to build future assessment instruments that will identify and monitor over time the ADL functioning in people with SLE and CI. Once the areas of ADL functioning have been identified than better treatments for improving ADL function can be developed, tested, and implemented in SLE clinical practices. This will help people stay involved in meaningful life activities, participate in their chosen life roles, and optimize quality of life.

Target audience: This information will be important for people living with SLE, caregivers, and SLE clinicians as changes in ADL functions can often be the first sign of CI. Knowing what ADLs are specifically impacted by SLE related CI can help monitor functioning over time. Further, the results can help clinical practitioners in identifying and addressing ADL limitation areas important to people living with SLE related CI. Further, for clinical practitioners and academic researchers, the results will provide foundational evidence and identify areas for further research in an area of that currently lacks information.

Project Lay Summary:

Chronic joint pain, such as that experienced by those who suffer from arthritis, is a common cause of disability that is difficult to treat and is poorly understood. The symptoms of chronic pain reported by arthritis patients closely resemble those reported by patients with nerve injuries. This suggests that arthritis pain might be caused, at least in part, by injury and inflammation of the nerves in addition to damage and inflammation at the joint site. We already know that inflammation within the upstream circuitry (ie. spinal cord) of pain sensation can activate pain pathways to a point where pain originating from the joint is amplified in the spinal cord further enhancing the feeling of a painful stimulus. What we don’t know is how much this type of nervous system ‘pain’ actually contributes to a patients experience of pain. As such, we aim to further understand the mechanisms of how this type of nervous system inflammation sustains or contributes to pain sensation. The first aim of these studies is to define and quantify the molecules associated with immune cells and nerve cells that are activated during chronic joint pain. To do this we will use the latest technology to isolate thousands of individual cells, such as immune cells and nerve cells, from the pain pathway at key time points in a rodent model of chronic joint pain (ACL transection injury at 16 weeks post-injury). We will then perform an unbiased sequencing experiment where we can detect the activation profile of these cells in pain states versus the same cells in healthy conditions. We will also compare this to another pain model that is already well characterized to be driven primarily by nervous system mechanisms of pain. We believe that any common mechanisms will likely be strong therapeutic targets. Such an approach is creative because it will allow us to focus on meaningful mechanisms of pain rather than tissue specific changes that may correlate with pain but not necessarily play a role in driving pain. The second aim is to modulate these pathways with the goal of preventing or limiting the development of chronic arthritis pain. We hope to not only uncover the underlying mechanisms of chronic joint pain but also identify therapeutically relevant pathways that can be targeted to treat chronic pain in the clinic.

Project Lay Summary:

“Zachary lived with the pain of arthritis for nine months. Despite the fact that he knows that the medicine in the injections is making him feel better, it doesn’t make it any easier to receive the painful poke each day” [35]. Around 24,000 children across Canada live with Juvenile Idiopathic Arthritis (JIA) [1], making it one of the most common childhood chronic illnesses [2]. Pain is the most frequently reported symptom [3], caused by both the illness itself and its associated treatments. Treatment aims to manage the pain and prevent damage to the joint tissues through both medication and physical therapy [4], which when followed leads to improved outcomes [5-11]. Unfortunately, following these recommendations can be hard [6, 12-23]; many of the treatments are painful (e.g., weekly injections), or have uncomfortable side effects (e.g., nausea) [24-29]. While pain is usually something we try to avoid [61], this is not ideal when it comes to treatment-related pain. It can be difficult for a child to understand how something that hurts can be good for them, so we must rely on parents to encourage treatment adherence. Parents however, are stuck between knowing what’s best for their child, and not wanting to see their child in pain. Previous research tells us that parents behaviours and beliefs regarding their child’s experience of pain may be related to avoidance behaviours [30-32]. Now we would like to see how parents might have an effect on treatment adherence in children with JIA.

This study will look at whether parent-level factors relate to treatment adherence in children with JIA. We expect that parents who cope by avoiding things, have negative feelings about pain and medication, have little knowledge of pain-management, and score higher on fear of pain and pain catastrophizing scales will have children who are less adherent to their treatment plan.

Parents of children with JIA will be recruited via social media with the help of Cassie & Friends [33]. All families in Canada with a child under the age of 18 who has been diagnosed with JIA will be eligible. After agreeing to participate, parents will fill out online questionnaires about their child’s diagnosis and treatment, adherence, coping, self-efficacy, fear of pain, catastrophizing, and their own knowledge and attitudes regarding pain. Some of the participants will also be interviewed to better understand the barriers they face when following treatments. Analyses will determine how these parent-level factors relate to treatment adherence.

The proposed study may identify how the parent’s beliefs and knowledge around pain relate to treatment adherence, which can have significant effects on their child’s health and well-being [5-7, 34]. Once parent factors are identified, we would like to teach families ways to manage pain to see if this will reduce parental fears and anxieties. JIA is a chronic disease that has long-term effects on physical health, education, employment, mood, and relationships [71-73]. We hope that results from this study will contribute to improving treatment adherence and these long-term outcomes for children with JIA across Canada.

Project Lay Summary:

Osteoarthritis (OA) is the most common form of arthritis, typically affecting women at higher rates than men. OA is a painful and debilitating condition that results from the body’s failed attempt to repair damaged joint tissues. The most traditionally prescribed treatments for OA patients, non-steroidal anti-inflammatory drugs (NSAIDs), do not work for all patients and with long-term use these drugs often become less effective and can cause unwanted side effects.

Approximately 60% of people suffering from OA cite poor management of their chronic pain and this is the number one reason for patients to visit their physician. Unsatisfactory pain management is possibly due to a third of OA patients developing neuropathic pain, where the nerves within the affected joint are damaged as the disease progresses. Neuropathic pain symptoms (e.g. shooting or burning pain, “pins and needles”, numbness) are more common among women and this type of pain is resistant to traditionally used treatments. Therefore, the discovery of new drugs for treating joint neuropathic pain symptoms is necessary in combatting OA pain.

We believe that the nerves are damaged, in part, by enzymes such as serine proteinases—which are commonly found in arthritic joints. In this project, I aim to identify specific serine proteinases which may be useful targets for OA pain and then explore the analgesic ability of these serine proteinase modulators in a model of OA. The level of serine proteinases in arthritic patient’s joints will be assessed to determine if the concentration and type of proteinases present correlate with the stage of disease. Using an injury model of OA, I will study the progression of knee joint pain and nerve damage in both male and female animals, and determine if drugs targeting serine proteinases can provide pain relief once nerve damage has occurred. I will also explore whether chronic treatment with these drugs can prevent nerve damage.

This project will (1) enhance our understanding of OA pain and (2) also identify important sex-specific mechanisms underlying the difference in prevalence of OA and neuropathic pain in women and men. The results of these experiments may point towards new and sex-specific targets for drugs used to treat joint neuropathic pain.

Project Lay Summary:

The Arthritis Society lists diffuse idiopathic skeletal hyperostosis (DISH) as the second most common form of arthritis (after osteoarthritis) with a prevalence of 15-25% of North Americans over the age of 50. However, health professionals are often unfamiliar with DISH, and consequently it is underdiagnosed and often misdiagnosed. DISH is typically diagnosed through x-ray detection of aberrant calcification of the soft connective tissues of the spine, including ligaments and intervertebral discs (IVDs). Symptoms are typically mild in the early stages of disease, including thoracic spine pain and stiffness. As such, patients are not often seen until advanced stages where the formation of ectopic calcified material affects adjacent anatomy causing dysphagia (difficulty swallowing) and/or compression of the spinal cord and adjacent nerve roots. To date, no studies have evaluated the effectiveness of any therapy in this disease, likely reflecting our poor understanding of its pathogenesis. This knowledge gap is due to limited access to human disease tissues and a lack of animal models that allow researchers to study events associated with disease onset. Consequently, apart from surgical removal of calcified tissues in severe cases, no disease-modifying treatments exist. Therefore, there is an urgent need for research studies aimed at understanding the biological mechanisms that contribute to the pathogenesis of DISH.

Our study applies technologies allowing for an unbiased screen of tissues affected by ectopic calcification to uncover the cellular and molecular underpinnings of DISH. This work is based on the use of a mouse model that our group recently reported as the first pre-clinical model of DISH (mice genetically altered to lack the gene encoding the ENT1 transport protein). This mouse model shows a remarkably reproducible temporal and spatial pattern of spine calcification resembling DISH and thus allows us to not only evaluate changes associated with the diseased state but also investigate predictors of DISH susceptibility and evaluate therapeutics. Since DISH affects the intervertebral disc, and we are experts in disc biology, we will investigate changes in this tissue to extrapolate findings to other connective tissues affected with the disease.

Our experimental strategy involves cutting edge technologies to conduct global analyses of tissues both prior to and associated with the onset of DISH-like calcification. Taking a multi-pronged approach, we aim to identify changes in: i) gene expression, ii) protein expression, and iii) metabolites associated with ectopic calcifications of spinal tissues in our mouse model of DISH. We will integrate the findings from each analysis and validate our findings in human tissues to develop a holistic view of the biology associated with DISH.

Overall, these studies aim to impact our understanding of arthritis by: i) identifying the biological pathways that lead to DISH, ii) identifying biomarkers to allow early-stage detection of DISH, ii) identify therapeutic targets to prevent or delay the onset of ectopic calcifications in DISH and associated disorders. This research integrates a collaborative, transdisciplinary team that includes biologists, technical specialists, clinicians and patient partners to ensure that in the long term, our findings impact the care of arthritis patients.

Arthritis Centres are the rheumatology division of the department of medicine in Canadian universities, including accredited pediatric rheumatology centres.

For over 30 years, the Arthritis Society has provided annual funding to Arthritis Centres across Canada. As centres of clinical expertise, research and education, their role in the Canadian health care environment is to help ensure that more Canadians with arthritis receive better care.

Current funding recipients (2017/18) of $15,000 for a term of one year are:

McMaster University

SickKids Hospital, University of Toronto

Research Institute of MUHC, McGill University

Montreal Children’s Hospital, McGill University

University of Manitoba

University of Calgary

Dalhousie University

CHU de Quebec, Université Laval

University of Saskatchewan

University of Alberta

Arthritis Centre grants support Centres that align with one or more of the following goals:

Every year, the field of rheumatology changes with new knowledge collected by research scientists from across Canada and around the world. Translation of this knowledge is important for the development of evidence-based rheumatology practice. Since allied health professionals play a large role in rheumatology, it is important that they be able to provide evidence for their roles in the field and demonstrate the positive impact that they have on the care of people with inflammatory arthritic disease. The AHPA encourages its members to contribute knowledge to the field by holding an annual research grant competition and recognizing their research efforts at the Canadian Rheumatology Association’s and AHPA’s Annual Scientific Meeting. An award of $5000 will be honored for the best research proposal submitted by an AHPA member. A list of recipients of this award can be found here.

The iPeer2Peer Program for Youth with Juvenile Idiopathic Arthritis: A Multisite Randomized Controlled TrialJennifer Stinson

A population-based analysis of multi-disciplinary rheumatology nursing care for people with complex musculoskeletal disordersMark Harrison